术中应用小剂量曲马多加氟哌利多对硬腰联合麻醉后不良反应的临床研究

目的探讨小剂量曲马多加氟哌利多对临床硬腰联合麻醉后出现的低血压、恶心、呕吐及寒战等不良反应的预防及治疗作用。方法将90例硬腰联合麻醉下行腹部和下肢手术的患者随机分为A、B组和对照组各30例。A组在麻醉穿刺成功手术开始前静注曲马多1mg/kg;B组在麻醉穿刺成功手术开始前静注曲马多1mg/kg,间隔10min后加静注氟哌利多0.1mg/kg;对照组单纯静注生理盐水,注射时间及ml数同A、B组。记录麻醉开始后3h内低血压、恶心、呕吐及寒战等不良反应的发生情况。结果 A、B组不良反应发生率明显低于对照组;A组明显低于B组(P0.05)。结论曲马多合并氟哌利多对预防麻醉后相关不良反应安全有效。     

曲马多复合氟哌利多用于控制剖宫产术中寒战

目的观察曲马多复合氟哌利多抑制剖宫产硬膜外麻醉期间寒战的效果。方法选择剖宫产术中发生寒战产妇60例，随机分为A组（曲马多复合氟哌利多组）30例，静脉分别注射氟哌利多2．5mg与曲马多1mg／kg；B组（曲马多组）30例，静脉注射曲马多1mg／kg。观察寒战消失情况及副作用。结果A组和B组寒战减弱至消失的时间相一致，但A组副作用明显少于B组（P〈0．01）。结论曲马多复合氟哌利多治疗剖宫产术中寒战明显优于单纯使用曲马多。     

托烷司琼复合氟哌利多预防腹腔镜术后恶心呕吐的临床观察

目的探讨托烷司琼复合氟哌利多对腹腔镜术后恶心呕吐（PONV）的预防效果。方法160例ASAⅠ-Ⅱ级腹腔镜胆囊切除术（LC）及妇科腹腔镜手术病人,年龄18—60岁,随机分为A组（氟哌利多组）、B组（托烷司琼组）、C组（托烷司琼＋氟哌利多组）、D组（对照组）;观察围术期病人生命体征及24h内PONV发生情况及严重程度。结果A、B、C组恶心及呕吐发生率明显低于D组（P〈0．05）,与A组和B组比较,C组的恶心及呕吐发生率明显降低（P〈0．05）。结论预注托烷司琼联合小剂量氟哌利多可较好地预防腹腔镜手术麻醉后PONV的发生,比单独使用时效果更好。     

曲马多复合氟哌利多不同途径治疗硬膜外麻醉期间寒战的临床观察

目的：观察曲马多复合氟哌利多不同途径治疗硬膜外麻醉期间出现寒战的临床效果。方法：选择ASAⅠ～Ⅱ级择期手术患者，在硬膜外麻醉期间出现寒战者60例，按给药途径随机分为3组(每组20例)：硬膜外 静脉组(Ⅰ组)，单纯硬膜外组(Ⅱ组)，单纯静脉组(Ⅲ组)。Ⅰ组静脉注入曲马多1mg／kg 氟哌利多0．025mg／kg，并同时从硬膜外导管注入曲马多1mg／kg 氟哌利多0．025mg／kg；Ⅱ组从硬膜外导管注入曲马多2mg／kg 氟哌利多0．05mg／kg；Ⅲ组静脉注入曲马多2mg／kg 氟哌利多0．05mg／kg，记录各组用药后寒战消失时间、不良反应、寒战复发例数和MAP、HR及SpO2变化。结果:Ⅰ组、Ⅲ组3min内寒战停止例数明显多于Ⅱ组，10min后3组寒战停止例数无明显差异；Ⅱ组、Ⅲ组寒战复发例数多于Ⅰ组，但无统计学差异；Ⅲ组并发恶心例数明显多于Ⅰ组和Ⅱ组，舒适例数Ⅲ组最少；Ⅲ组用药后MAP、SpO2下降明显于Ⅰ组、Ⅱ组。结论：曲马多复合氟哌利多是一种治疗硬膜外麻醉期间寒战的有效方法，且硬膜外和静脉同时分量给药效果最佳。     

曲马多与芬太尼治疗硬膜外麻醉期间寒战的对比观察

目的：观察曲马多辅用氟哌利多与芬太尼辅用氟哌利多治疗硬膜外麻醉期间寒战的效果。方法：选择ASAⅠ—Ⅱ级,择期手术,在硬膜外麻醉期间出现末战者60例,随机分成2组,芬太尼加氟哌利多组（A组）和曲马多加氟哌利多组（B组）,每组30例。当寒战出现持续2min不消失时,A组静脉缓注芬太尼1．5μg／kg加氟哌利多0．05mg／kg,B组静脉缓注曲马多1．5mg／kg加氟哌利多0．05mg／kg。观察注药后2min、5min和10min寒战级别变化,副作用及MAP、SPO2、HR和RR的改变。结果：注药后2min寒战消失者A组18例,占60％;B组27例,占90％,两组同时点比较P〈0．05,差异有显著性。A组注药后SPO2稍有下降,两组比较无统计学差异。结论：曲马多辅用氟哌利多治疗硬膜外麻醉期间寒战优于芬太尼辅用氟哌利多。     

哌氟合剂及曲马多伍用氟哌利多治疗硬膜外麻醉期间寒战效果的体会

目的 观察哌氟合剂及曲马多伍用氟哌利多治疗硬膜外麻醉期间寒战的临床效果.方法 随机选择在硬膜外麻醉下手术期间出现寒战者60例,分为两组:A组(n=30)给予哌替啶0.5 mg/kg,氟哌利多0.05mg/kg;B组(n=30)给予曲马多1.0mg/kg,氟哌利多O.05mg/kg.当寒战发生时静脉分别给予哌氟合剂或曲马多伍用氟哌利多.结果 A组和B组注药后药物的起效速度及效果比较差异均无统计学意义(P＞0.05),但A组的HR、SpO2用药前后差异有统计学意义(P＜0.05),而B组的HR、SpO2用药前后差异无统计学意义(P＞0.05).结论 曲马多伍用氟哌利多治疗硬膜外麻醉期问寒战的效果优于哌氟合剂.     

昂丹司琼、氟哌利多复合地塞米松对预防PCEA的恶心呕吐的效果观察

目的本文观察并比较昂丹司琼、氟哌利多复合地塞米松对术后硬膜外吗啡自控镇痛(PCEA)恶心呕吐的预防作用。方法选择腰硬联合麻醉下择期手术120例,术后均行PCEA镇痛。随机分成四组,每组30例。A组单纯吗啡组B组吗啡+氟哌利多组,静脉给地塞米松C组吗啡+氟哌利多,静脉给昂丹司琼;D组吗啡+氟哌利多,静脉给昂丹司琼、地塞米松。观察术后24小时内恶心呕吐的发生情况。结果与A组比较,B、C、D组恶心呕吐发生率、严重程度明显降低(P<0.05或P<0.01),其中,D组恶心呕吐发生率最低。结论昂丹司琼、氟哌利多复合地塞米松可明显减少PCEA泵恶心呕吐的发生。     

托烷司琼预防妇科术后镇痛恶心呕吐的临床观察

目的：观察托烷司琼在不同方式给药时预防妇科手术后静脉镇痛（PCIA）恶心呕吐（PONV）的临床效果。方法：硬膜外麻醉下妇科手术患者行PCIA,90例患者分为3组,每组30例,A组术前给予托烷司琼,B组将托烷司琼加入镇痛泵中持续注入,C组镇痛泵中加入氟哌利多。观察术后24 h发生恶心、呕吐等不良反应情况。结果：PONV发生率A、B两组低于C组,差异有统计学意义（P〈0.05）。B组PONV发生率与A组比较差异无统计学意义（P〉0.05）。结论：妇科手术后PCIA预防恶心、呕吐时,使用托烷司琼效果明显好于氟哌利多,术前用药和术后用药均有很好的疗效。     

格拉斯琼预防曲马多复合静脉麻醉术后镇痛恶心、呕吐的疗效观察

目的：观察格拉斯琼对曲马多静脉复合麻醉术后镇痛（PCA）恶心、呕吐的预防作用。方法：将90例择期手术病人随机分为三组：对照组;氟哌利多组;格拉斯琼组。三组均采用曲马多静脉术后镇痛,所不同的是对照组镇痛配方中无格拉斯琼和氟哌利多,氟哌利多组镇痛配方中加入氟哌利多,格拉斯琼组镇痛配方中加入格拉斯琼,随访记录病人术后48小时内恶心呕吐的发生。结果：对照组恶心呕吐发生率明显高于格拉斯琼组和氟哌利多组;格拉斯琼对于预防术后恶心、呕吐的作用优于氟哌利多,氟哌利多组嗜睡的病例较格拉斯琼组和对照组明显增多。结论：格拉斯琼用于预防曲马多术后镇痛恶心、呕吐优于氟哌利多。     

阿扎司琼与氟哌利多在预防全身麻醉下妇科手术术后恶心呕吐的对比研究

目的：观察在全身麻醉下妇科手术中应用阿扎司琼与氟哌利多预防术后恶心、呕吐（PONV）的效果。方法：选择子宫切除术患者120例,均采用静吸复合麻醉,随机分为A、B、C、三组,A组（阿扎司琼组）、B组（氟哌利多组）、C组（对照组）,手术结束前30min A组患者静脉注射阿扎司琼,B组患者静脉注射氟哌利多,C组静脉注射0.9%氯化钠溶液作为对照。观察手术后病人PONV的发生情况及严重程度。结果：A、B两组恶心、呕吐发生率明显低于C组（P〈O.01）,术后24h内阿扎司琼和氟哌利多完全抑制PONV的有效率分别为73.0%和71.0%,术后恶心发生率分别为15.0%和20.0%。术后呕吐发生率分别为10.O%和12.0%。A、B两组完全抑制PONV的有效率、术后恶心及呕吐发生率两组间比较差异均无显著性（P〉0.05）。结论：手术结束前30min静脉注射阿扎司琼或氟哌利多均能有效预防PONV,与氟哌利多相比,阿扎司琼并无明显优势。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.